I started a conversation with a young scholar a few weeks ago about her work in communications that I realized has some interesting implications for unintended consequences of this campaign. I've interviewed her with that in mind. Let me introduce Dr. Mary Beth Asbury, Assistant Professor of Organizational Communication at Middle Tennessee State University, who has a Ph.D. in Communication Studies at the University of Kansas. Her dissertation research looks at weight as a social identity among women. Here is my interview with her:

DR. ASBURY: Throughout my graduate career, I have had interests in many subjects, including everything from hate speech to organizational and health communication. While some might argue that this pattern presents a scattered approach to studying communication, it is by exploring and taking a variety of classes that I have been able to truly find my passion. Through various studies and much trial and error, I have found that most of my research has a unifying factor—the concept of identity.

When I began my Ph.D. program, I focused on identity in organizational and small group settings. Thus, I took many classes in those areas to learn about those specific contexts. It was in these classes that I found a connection to health and interpersonal communication, for I began to study identity in terms of weight loss organizations, namely Weight Watchers. The first study I did examined weight loss discussion boards. When I was doing the study, it was like I was finding myself as I researched this topic, for weight is something that I have struggled with my entire life.

As I got down to the dissertation phase, I wondered if my experiences with weight were unique. The "perfect" weight (which seemed to vary because I never seemed to reach it), was always the life goal of mine. In fact, the only way I could think about myself was in terms of my weight. Even now, I find myself in the trap of thinking, "If I were thinner, everything would be better." I decided for my dissertation that I wanted to see if it was just me who thought this way. So, my dissertation focused on the question: "Do we have a weight identity?" Using a social identity theory perspective, I argued that research has shown that we have identities associated with our age, physical disability status, and ethnicity. All of these concepts are both physical (e.g., we can look at a person and see how old they are or what race they are), but they are also socially constructed, meaning that society tells people what it means to be a certain age (e.g., older adults may be stereotyped to be slower or wiser). I argued that weight is the same way—it is both a physical characteristic (i.e., we can see how much space a person takes up), but society tells people what it means to be a certain weight (e.g., thin is better, and the stigma associated with being overweight).

For my dissertation, I interviewed women in three BMI weight categories—underweight, "normal" weight, and overweight/obese. I asked them questions about their weight, food, etc.

DR. THOMAS: What were your findings in your dissertation and further research?

DR. ASBURY: What I found with my dissertation was that weight has the properties of a social identity, meaning that it has cognitive components (e.g., I think about my weight), affective components (e.g., I feel things about my weight), and behavioral components (e.g., I act a certain way if I see myself as overweight, underweight, or "normal" weight). This conclusion was also reinforced by which weight group seemed to have the strongest identity with their weight, for those in the overweight/obese group thought about weight more, had stronger feelings about their weight, and enacted certain behaviors about their weight. For example, those in the overweight/obese group noted that weight was "always on their mind." They also noted that they were more likely to feel good or bad about themselves based on their weight. Moreover, they enacted certain behaviors based on their weight. Several talked about not wearing certain clothes they wanted to wear or referenced not doing activities they wanted to do because of their weight. These notions reinforce that this is an identity, for social identity research notes that we are most likely to see evidence of an identity in groups that are not the social norm. For example, we know that individuals have an ethnic identity, but we see that most in minority groups.

In addition, based on this research, I found that individuals whose families did not make a big deal out of weight (whether they were underweight, normal weight, or overweight) were more likely to be "normal" weight (according to BMI). Moreover, these women had better self-esteems and exhibited healthy practices on their own (i.e., making healthier choices regarding food intake and exercise). Basically, all of this research has led me to the conclusion that a "war on fat," which seems to be prevalent terminology with government agencies, medical professionals, and practitioners, is actually leading to the opposite of their goals. Instead of telling people some foods are "good" or "bad" or some weights are "good" or "bad," we need to instead be making people feel good about their bodies, regardless of the size. If we do not make a big deal out of weight, we might actually get the results we want. And, end up with HEALTHIER people, which should be the actual goal.

DR. THOMAS: How important is the way we talk about our bodies and/or about weight? Do you think changing the way we speak might also change the way people are treated? How?

DR. ASBURY: How we talk about our weight and bodies is incredibly important. In my dissertation research, ALL of the women were able to remember comments about their weight that they heard from others. The first question I asked was "Can you recall a comment about your weight?" and in all instances, the answer was yes. For almost all of the participants, the comments were negative. These comments affect us deeply and lead to how we feel about ourselves in terms of our bodies. Even when these comments occurred 20 years ago, the respondents were able to recall them very accurately and describe in detail how they made them feel then and now. Thus, how we talk about our weight affects us deeply for a long time.

But I think this question is an interesting one, for it ultimately comes down to the questions—does culture cause communication or does communication cause culture? I think the answer is yes—to both.

Currently, I think we have placed too much emphasis on the idea that culture causes our communication. The way society talks about weight and body shape, it places looking a certain way as a priority. This then influences how we perceive ourselves. For example, if I do not have the slim figure of Jennifer Aniston, I feel bad about myself, I put myself down, and I enact behaviors to try to achieve that body. Thus, culture is causing the communication. At the moment, I think society is under the impression that they are being spoon-fed what how and how to think.

But what people do not understand is that their communication can also influence the culture. We do have a say in how our culture is shaped through our communication and our behaviors. For example, if I choose to speak about my body only in positive terms, and I also choose to not put others down in terms of their bodies, I am taking a step to say that this culture of "thin is in" is not going to affect me. And then perhaps that helps change the communication of others, especially if I tell them, "I find comments about weight to be inappropriate." Communication is an incredibly powerful phenomenon. I think that if people realized the power they have in their words and in their actions, they could effectively change this culture.

DR. THOMAS: There has been a great deal of controversy regarding a public service advertising campaign being sponsored by the Children's Healthcare of Atlanta's Strong4Life program. Specifically, the ads are using the images of larger kids supposedly asking their parents to watch their weight and what they eat because being a fat kid is so tough. What implications of your research would address this campaign and controversy?

DR. ASBURY: These ads are very upsetting. However, the irony of this whole situation is that by making these ads, Georgia may actually encourage some people to gain weight—the exact opposite of what they desire. I say this because in my dissertation, I examined whether individuals have a weight identity, a form of social identity that is similar to the identity we feel about our age, our sex, our ethnicity, our disability status, etc. My study found that weight is indeed a form of identity. How this relates to the Georgia ads is that social identity research tells us that whenever we feel our identity is threatened, we hold tight to that identity. Thus, we will often enact behaviors that show that we belong to that group. For example, if people tell me that "fat is bad," and I identify myself as "fat," I will do what I can to protect that identity, even when I am not happy with that identity. Thus, I will enact the behaviors of a "fat" person more overtly to show others I am standing firm in who I am. If Georgia wants people to enact healthy behaviors, the answer does not lie in shaming people, for it will only make people rebel against the idea.

DR. THOMAS: If you were to give suggestions to people about how to speak of bodies, what would you suggest?

DR. ASBURY: Everything can be summed up in one sentence: "Be nice to everyone at all times." But, more specifically, do not talk about weight or food. You should not label foods as "good" or "bad," nor should you label weights as "good" or "bad." The more emphasis we put on weight and food, the more likely we are to build up the importance of these items in our lives. This leads to us seeing food and weight as "battles" that we feel we can never overcome.

DR. THOMAS: Do you think there are particular groups of people, for example, doctors, teachers, parents, etc., who should pay more attention to how they speak of bodies and/or weight? Why or why not?

DR. ASBURY: I think the most important group that should watch what they say are parents. Most of the participants in my study noted that their comments came from parents, and those comments affected them deeply for a long time. If your parents do not accept you for your size, you begin to wonder who will? So, I think the most important relationship is parents.

Weight, in and of itself, is a medical issue. I do think that doctors could learn to be more sensitive, especially since weight is not just a physical issue but is also a psychological one (i.e., identity).

Teachers, peers, etc., should just never talk about a person's weight.

Weight is going to be an issue as long as we (meaning society) make it an important issue. If we would stop talking about it and quit building it up to be a "problem," I think we would be ok.

===================================

It is my hope that the CHOA will reconsider and reword their campaign and goals to encourage children of ALL sizes to eat well and move their bodies often and in enjoyable ways. If Dr. Asbury's research is any indication, encouraging the parents of Georgia to label their children and foods they eat as "good" and "bad" will have devastating effects. My thanks to Dr. Asbury for taking the time to speak with me.

This is the second of three posts in January in honor of a call to ReVolutions Not Resolutions. I hope you will investigate and join the movement to love and honor bodies of all shapes and sizes. If you'd like to join the fight against the Strong4Life campaign, this blog is a good resource (note the sidebar has info on who to contact).

I hadn't really thought of weight as being an identity until I found FA/SA, but reading this reminds of something that I used to do years ago, and was my way of rebelling against the diet culture and reinforcing my fat identity. Every time someone would talk about dieting - whether it was a friend, an ad on television or the radio, or an ad in a magazine - I would get hungry. I'm not talking hungry - it's time to eat, I'm talking hungry - I need to devour the world stuff. And I would search the cupboards/refrigerator for whatever looked good and eat until I couldn't eat any more. The only thing that kept me from continuing on that path was the fact that I had WLS (that failed) and every time I ate too much (anything over 1/2 cup), I got sick. I hate getting sick (one of the reasons I never binged and purged), so when it got to the point where I couldn't eat without getting sick, I had to find other ways to cope with the diet culture and reinforce my fat identity. Blogging (and ranting at the ads on TV) worked for me, as did deciding to live my life fat at the world and let the world deal with it.
So, yeah, S4L is really on the way to setting up kids for the same kind of crap I went through, and I wasn't even a kid when I went through it, I was an adult (and still found it difficult to deal with).

Thanks for sharing part of your story. I'm not sure why people do not get that we have been told and have attempted to comply with much of the advice that is still offered as "obvious" but I hope that if we keep talking as adults about what it has been like to grow up in a culture that has told us we were lazy and bad and wrong all our lives, that has said we are failures just because of how we look, will come to understand that we are indeed human and that we have indeed heard what they are saying.

I worry about the CHOA research that supposedly demonstrates parents are not understanding that something is wrong is basically the researchers assuming that if a parent isn't micromanaging their children's diets and activities they just don't understand. Or worse yet, assuming that because their kids are larger than their peers, they must not be listening. They have promised to share this research with us soon. I hope they are transparent. I want to see what they base this on because from my viewpoint where the discussion of weight is everywhere, I have a hard time understanding how anyone can really believe it is a lack of awareness.

Great points, both of you. One thing I think people overlook is that because weight is such an important issue in our society, everyone knows where they stand on that spectrum. It does not come as a shock to anyone that they are considered overweight/obese. Yet, doctors and especially those working on this Georgia campaign seem to think people do not know their weight status. In my study, all of the overweight/obese participants were able to correctly identify which BMI group to which they belonged. The group that most likely got it wrong were the underweight females, who, in all circumstances, considered themselves to be "normal" weight, which provides a good commentary on what society perceives to be "normal." If we want people to be healthier, we need to start considered things from the point of view of the patient, not the practitioner.

"...It does not come as a shock to anyone that they are considered overweight/obese..."

Well, not everybody, apparently. I heard pediatric cardiologist Dr. Brian McCrindle (Hospital for Sick Children, Toronto) speak at the Canadian Cardiovascular Congress recently on the subject of overweight physicians. He cited several studies suggesting that many docs have a completely unrealistic self-image. In a survey of pediatricians, for example, 40% were overweight based on BMI calculations, yet more than half of these physicians classified themselves as "normal" weight. Turns out that this delusion is important to their patients' health, too.

According to Dr. McCrindle, although physicians tend to list "a lack of patient motivation" (or parental support, in the case of kids) as a key reason for why they don't counsel patients to be more active or eat healthier, "other studies clearly show that patients are more likely to be receptive to counseling if their physicians appear to be of normal weight or if they are open about their own healthy habits".

I recently watched an obese mother at the Minneapolis airport pouring Coke into her baby's bottle. How does that woman's physician possibly reach such a parent "from the point of view of the patient"?

I love the article, but it seems to me that there has been research before that has demonstrated that weight is a social identity. I don't have time to look it up, but others have found fat people as a group have many of the same personality traits as other oppressed minorities. And much of what she says also sounds a bit like labeling theory too. Not that this should minimize her work in any way, it is VERY important. And needs to be documented and brought to our attention as many times as necessary until we stop the emotional abuse surrounding weight!

I didn't mean to imply by the headline that this was the first research or theory looking at weight identity. We even discussed "Fat Identity" in Taking Up Space including a discussion of weight loss, especially in its more drastic forms, as a type of "passing" in a Goffman-presentation-of-self meaning of passing.

I have not read the dissertation yet, but that disclaimer, I think a major contribution of Asbury's work is the primary aspect of speech and communication in creating this identity. I like that she has empirical evidence of what I think of as essentially a constructionist argument, that we build this culture of thinness through speaking about our weights just as much as the culture of thinness teaches us to speak about it.

I think this goes beyond labeling theory, which is looking at how self-fulfilling prophecies are often created within the labels a powerful ruling class places upon oppressed classes, to a theory of self and society in general -- culture is the sum total of micro-interactions. When we speak of weight, of "good" and of "bad," we are, in part, making these things significant and moral. We speak them into existence. We speak all meaning into existence and to the extent that we begin to agree, those meanings take on a life of their own. The extent to which institutional discourses coincide with these everyday practices, they become more powerful and help define what we thing and what we say. The circle is complete. We take from culture and we create culture at the same time. So more than power structures are involved and more than labels. (Disclosure: Jaber F. Gubrium was my committee chair -- my ideas are heavily influenced by his writings and teachings.)

Yes, I have read the research on "fat identity," but I wanted to expand that notion a bit in my dissertation. So far, we have considered this to be just a "fat" person's issue, when, really, we ALL have these identity issues. We just primarily see it in those who are not the norm (e.g., the overweight/obese and those with anorexia and bulimia nervosa). Even the "normal" weight participants spoke of things that indicated that they too have an identity.

In addition, Pattie is correct. Because I come from a communication standpoint, I wanted to add the elment of the importance of communication in establishing our "weight identities." We do not know we are "not the norm" in terms of our weight until someone tells us, and how they tell us influences how we think about our bodies, thus leading to the establishment of our "weight identities." We tend to think of "identity" as a purely psychological component, but what people do not realize is that communication is essential in establishing that identity, for identity is composed of all three - cognitive, affective, and behavioral components. Communication, in and of itself, is behavioral.

Since I don't like people talking about how fat I am, I am going to make everyone else conform to a new set of rules. You will not mention my weight, not talk about my weight, not even look at me or talk about eating.

I am overweight and obese so now I will make the rules. I am the one in control not the other 7 billion people on the planet. I will eat as much as I want, indulge as much as I want and YOU are to say nothing, nadda, nil. If the State of Georgia sees a problem with my new rules, if the state has to pay out more money in medical costs, has to deal with the social fall-out from having an obese population then the residents of Georgia will just have to pay more taxes for the additional costs and quit complaining.

We are talking about the implications of talking, not the control of talking. There is a huge difference. There are consequences to what we say. You speak of behavior. Our speaking is behavior.

First let me say that the idea of fat people controlling the world amuses me because the reality of living with fat stigma is exactly the opposite. Our power is somewhat limited in this culture and this shows up in our ability to find work, healthcare and justice. However, I have this impression that some people are really so afraid of being fat that they make fat people into all-powerful super-beings whose words can threaten the fabric of society and make all people instantly unhealthy. Of course, the truth of Dr. Asbury's work is that all words change the world, one interaction at a time, within the context of social and institutional power.

Your take on this is exactly what we are talking about when we say that people judge us on the basis of how we look. You have decided that in spite of several studies that have shown that dieting fails that being fat is simply a matter of diet and exercise and that every single fat person has done neither in their entire lives. Do you also believe that every thin person you meet eats a restricted diet and exercises frequently? On what do you base this assessment? Show me data that demonstrates ALL fat people live one lifestyle and ALL thin people live another. If this is not empirical observation of these populations, then it starts to fall into the realm of stereotyping and bigotry.

As far as controlling my own behavior -- every single diet I ever went on was ended by a doctor who told me I was hurting my health. I have been a highly disciplined person my entire life and my reward for this has been disability. I do projects with total commitment and for about 30 years of my life, dieting was a full-time project. What I know from my own experience and from what I've seen when dieting has been studied, it rarely works and if hurts health. If you indeed want to know more, I would suggest you read the research I've outlined at the end of this comment. The bottom line is that if diets do not work for the majority of the people, then making moral judgements about fat people's lifestyles are unfounded. I didn't blame others for my "failure" to lose weight. I came to a logical and scientific conclusion that the evidence suggested my health would be better if I stopped trying and started eating well and exercising regularly. While I still fight the effects of 30 years of fighting my body, my health has generally improved by putting the focus on health NOT weight. For the life of me, I still can't figure out why that is so threatening to other people.

As far as controlling others is concern, I do not advocate controlling anyone. I am strong believer in freedom and I abhor social control in any form. I do advocate that those who hold power and authority (like the CHOA) use that power and authority in a way that is useful for the public good. I do advocate that within public discourses others have a right and responsibility to cry out against misuse of said power and authority (I'm pretty sure that's supposed to be an "American" thing). I do believe that public discourse not government or social control should be the mechanism by which the public good is achieved.

Teaching kids that their bodies deserve to be bullied is not useful. And, btw, if you think the only kids who are being taught this lesson are fat kids, you know little of child psychology. This message of hating one's body is going to hurt any kid who buys into it, no matter what their body size if right now. Fear of being fat is just as much a problem as actually being fat in this culture. These ads are bad for ALL kids. Even people who advocate the fat is bad like the Obesity Action Coalition, the Rudd Institute and Dan Savage sees these ads as teaching kids that it is okay to bully and that if you are bullied it is your fault. That is the issue.

Research tells us what happened when people did things. It is always past-tense with the hope that future action can be guided by better knowledge. That is the whole point of scientific study. Dr. Asbury's research suggests that our talk about weight is hurting women and girls, creating a social identity that limits their lives. Is weight so important that we should hold back the life chances of children "for their own good"? What would be wrong with teaching positive healthy habits in lieu of negative body-hating messages? How is advocating such a thing an example of blaming someone else? I've asked this before on this blog, but if the eat healthy foods and exercise more crowd really believes what they say, then why not teach ALL kids to eat healthy foods and exercise? Why does the shape of their bodies (which are growing and changing) have to be part of the equation? What purpose does it serve to call a kid "overweight" or "obese"?

Advocating for a more balanced way of talking about our bodies and relegating talk of weight to a minor status rather than a major life event would help in this balance. But that is up to each individual. There is a vast difference between public discourse with a power organization running an ad campaign and the personal worlds of parents making parenting choices. No one is advocating censorship, control or ignorance. Please give me a quote from this post that says otherwise.

======Further Reading on Dieting Failure=======

>>Stunkard's 1959 study (ARCHIVES OF INTERNAL MEDICINE 103(1):79-85 Stunkard AJ; MCLAREN-HUME M, The Results of Treatment For Obesity - A Review of the Literature and Report of a Series, 1959) which found that weight loss could not be achieved permanently simply through diet control (yes, we knew this in 1959!)

>>The 1992 NIH Consensus Statement on Methods of Voluntary Weight Loss and Control (http://consensus.nih.gov/1992/1992WeightLossta010html.htm) which reviewed the small body of studies of weight loss attempts and found there none of the current methods of dieting worked permanently, with almost all dieters regaining the weight they lost within 5 years (note that most "success" data is limited to one year studies).

>>Another 1992 report, from the Office of Prevention, Education, and Control National Heart, Lung, and Blood Institute (http://www.nhlbi.nih.gov/health/prof/heart/obesity/wtob.txt), which had this little nugget: "Dr. JoAnn Manson stated that the benefits of long-term weight loss cannot yet be fully addressed because not enough individuals have sustained long-term weight loss." Yes, we DO NOT KNOW if weight loss really has the benefits we believe. The data that is used to tell people they need to lose weight is based upon the comorbidities that are seen among higher BMIs and it is just postulation that actually losing weight and keeping it off will lead to long-term health benefits, but since few people can succeed at this task, it has not been studied.

>>Finally, Linda Bacon's study, which actually followed real dieters and non-dieters over a period of two years (something that has been rarely done outside of commercial interests, who most tellingly rarely publish their results in an unbiased fashion). Bacon, L, VanLoan M , Stern JS, Keim N. Size Acceptance and Intuitive Eating Improve Health for Obese Female Chronic Dieters. Journal of American Dietetic Association. 2005;105:929-936. Her study found, among other things, that healthy outcomes (improved metabolic numbers and mental health factors) could be achieved WITHOUT weight loss among women with fairly high BMIs.

I really miss the days when people were accepted as coming in all shapes and sizes and their weight wasn't really other people's territory. Fat people were just fat and it was only one thing about them, not considered a whole statement on how they were (obviously) living their selfish, lazy, ignorant, immoral lives as people seem to think now.

As a person who has been at both ends of the bmi chart, I most resent the implication that because I am fat now, I am too dumb to know how to eat or what I need to be healthy. However, I do realize that people tend to think in terms of black and white, and the vast majority of people don't deal well with complexity. As a highly educated professional, I also resent the fact that many people think being thin is totally a matter of eating next to nothing and exercising like a hamster on speed. The final thing I hate about the whole argument (because there is an implicit argument in most statements about body weight these days that goes something like "thin is better, no matter what you have to do to get there and all degrees of fat are unhealthy") is that the nation seems to be trying to indoctrinate a whole generation with the idea that if they are not perfectly thin, then there is something major wrong with them and with their family. Just a little critical thinking and reading of the recent research will show that the issue is not a simple one.

I agree completely with the premise that the current campaign to demonize fat families and fat kids will not alleviate the problem, but will have the opposite effect.

Statistics show that obesity is often associated with lower incomes and less education. How can we make sense of that statement?

As humans, we need basically three conditions to make sure that we feel reasonably well and our needs are not substituted with feel-good-food or by emotional eating.

1. We need to understand what is going on in our own lives

2. We need to ability to shape and influence our own lives

3. We need to be able to feel that whatever happens around us makes sense and that we have found our place in our families and in society

These three key points are the foundation of what keeps us healthy, and, ultimately, at a normal weight.

Are these three components often lacking with poorer and less educated people?

Yes, as they no longer feel that they can shape anything to their desire due to the lack of funds or the lack of being needed or the feeling of not being able to make a difference. Even managers in corporations seem to break down, fall ill or end up with depressions when their creative freedom to shape events is somehow curtailed.

Most people who ended up at the edge of society due to unemployment or poverty rarely feel that they are needed anymore; they rarely feel that they are able to make a difference in anybody's life anymore. They also might have lost the sense of understanding on how to change their situations and what their life's purpose might be, even though as child they, like everybody else, were hopeful that they would find a place in this life in which they would be able to bring meaning to theirs and other people's lives. Lacking this kind of fulfillment is as if constantly living with some sort of craving and desire for something that cannot be satisfied or reached.

And this unfulfilled desire leads directly to overeating?

Especially for those who have learned as early as childhood that problems can be substituted with candy; children who fall down or cry get something sweet to ease the pain. Especially parents of poorer and lesser educated backgrounds are prime examples of customers who keep buying chocolate bars and other junk foods; they keep buying this stuff even though they actually have very little money available. But this audience is of course also very susceptible to advertising because they have had so many problems early on in their lives and have learned that they cannot really solve their problems, but rather only satisfy - and substitute - their desire for change and a better life.

So can this be considered a social problem?

Yes, in some ways these people are holding up a mirror in front of society and show where things are headed when people no longer care for one another; when people end up being labeled and stereotyped and are no longer given the room or the opportunity to make a real difference in theirs and other people's lives. From this point of view, then, being unemployed is not so much a problem because of the lack of funds, but it becomes a huge problem because of the lack of meaning; because one can no longer contribute to society in a meaningful way.

Is this the reason weight loss classes on healthy eating don't work so well?

To decide how to behave in certain life situations is based one's life experiences up until now. Anyone who has learned that sweet and fatty foods will help satisfy their desires has developed an attitude like "If I am a little fat, what does it not matter?" or "The main thing to me is that it tastes good." These attitudes are not purely cognitive, (i.e. we're not always thinking about it), but stem from experience and conditioning. And every experience is distinguished by something that gets under one's skin; something that is linked with a powerful feeling or emotion. Both components, the emotional and the cognitive link combined, will eventually lead to a conviction that a particular behavior is good for us, even if it is overeating bad foods.

So lecturing alone won't help?

Exactly, because this approach won't reach the emotional components. You cannot change an attitude by convincing people because you only reach the cognitive component; and you can not achieve change by punishing or hugging them all the time because you only reach the emotional components that way.

So what will help?

You should invite such people to encourage and inspire a new and different experience with themselves. For example, moving their bodies so that they can feel and get in touch and experience their own bodies again; or in relationships with other people, where they realize that they can actually talk with others without feeling bad or ashamed and where they feel that they can talk about problems and solutions as well. And, of course, in relationship to their role in this world and in society, where they realize that they are able to partake in shaping it and making a difference. For these steps to work, nutritional counseling alone is far from being enough. It sometimes takes the help of a psychotherapists or a life coach.

Some might ask: Why won't big people achieve this by themselves? They only need to get their act together.

This is the talk of the educated middle class, which itself had enough opportunity to take responsibility for their own lives and have thus learned that they can make it. But for those who are are used to not being able to succeed in anything and those who didn't have any positive experience in changing themselves and those who were ridiculed at their whole life – how can they possibly have an experience of taking on self-responsibility? For these people the cognitive and emotional reasoning is so strongly developed and intertwined that breaking through and letting go of their substitute behavior of overeating is rather difficult.

So we need a new approach towards helping people lose weight?

What we need is another relationship culture at home, at school, at work and in our communities. If our living together becomes so empowered that everybody can find their place in society and recognizes themselves as valuable to other people, we wouldn't have many obesity problems. I am firmly convinced of this.

While I can see that you are offering a kinder, gentler approach than something like Strong4Life, I would suggest there are some assumptions you are making that could have alternative explanations.

First, it is true that BMI and socioeconomic levels are correlated. But the explanation for this relationship might be spurious. There is also a high correlation between ethnicity and body weight, with African Americans and Latinos have higher BMIs than the general population. Since these two groups (along with Native Americans) are vastly over-represented among the poor, it might be natural variation that accounts for this relationship. Also, higher socioeconomic levels provide resources for drastic methods of weight loss such as weight loss surgery, liposuction and high regimentation (exercise coach, chef, etc.--look at Oprah's trips up and down the scale). So it may be that the upper classes are artificially reducing their natural body weights. Finally, thin is rewarded with better jobs and higher pay than fat, so you have a circular pattern -- don't give fat people good jobs and then ask why they are over-represented among the poor.

I am not saying that any of these explanations are true. I am only saying that one must not assume that correlation equals cause and to establish cause, one must consider alternative explanations. These explanations needed to then be tested. To my knowledge, little has been done to test any explanation of these correlations because the assumption with higher BMIs usually is that it is important to lower the BMI no matter what.

Second, I think you are making a lot of assumptions regarding poverty, poor people and uneducated people. To assume that poverty is long lasting is a myth. There are only two geographical places in the United States where poverty is multi-generational and long-lasting: the Appalachians and larger inner-cities. Most people do not stay below the poverty line for long. While we are going through an economic downturn at the moment and more people are poorer and staying poorer for longer, it is doubtful that these individuals will remain poor for a lifetime. "Poor people" is not an apriori category. One is not born poor in the sense that one is born with specific ethnic histories. Poverty is not genetic. In fact, some studies have indicated that the newly impoverished have a much harder time (with the symptoms you describe) than those who have had to deal with flirting around the poverty line for a while. Suggesting that all people with low incomes who are unemployed or underemployed feel and act the same way is stereotyping. People who are struggling with economic troubles are diverse. I grew up in a lower socioeconomic, working class neighborhood and have had dealings with a lot of people who struggle to keep things going. I've known many of them who fully understand themselves are strong contributors to their social worlds. Many of them are politically active, many of them are pillars of their communities, often helping out their neighbors, and many of them live meaningful lives.

Finally, exactly why is weight-loss an answer to anything that is part of your life when you are struggling financially? Poverty usually involves survival, including finding affordable housing and food insecurity. In Georgia, 20% of the children are living below the poverty level and they are suffering because they can't find food. Telling them they should go on a diet and lose weight is insulting, especially because there is little evidence that weight loss will improve their health.

It is easy to talk about "empowering" people, but the truth is that as long as injustice and inequality exist, people will be limited by these things. Taking an individual perspective instead of a social, collective one is a game played by those in power to make it look like it's just a matter of trying harder or believing in yourself. I agree we need a new culture and that people should be able to pursue their "place in society and recognize themselves as valuable." But that culture needs to include social empathy, egalitarian social systems and an economic system that isn't so lopsided that 5% of the population control 40% of the wealth. My guess is that public health would improve if 50 million people had access to health care and if the pharmaceutical-industrial complex stopped price-gouging. So let's also work for a culture that recognizes health care as a right, not a privilege.

Thanks for this excellent article and interview. I find it incredibly ironic and depressing that all of the AdChoice ads to the right of the article are advocating weightloss, having weightloss goals, diet pills, and bariatric surgery. I'm not sure that it's possible to illustrate more clearly the nature of the weightloss-at-all-costs culture we swim in on a daily basis.